TY - JOUR
T1 - Survival Effect of Nephroureterectomy in Metastatic Upper Urinary Tract Urothelial Carcinoma
AU - Nazzani, Sebastiano
AU - Preisser, Felix
AU - Mazzone, Elio
AU - Marchioni, Michele
AU - Bandini, Marco
AU - Tian, Zhe
AU - Mistretta, Francesco A.
AU - Shariat, Shahrokh F.
AU - Soulières, Denis
AU - Saad, Fred
AU - Montanari, Emanuele
AU - Luzzago, Stefano
AU - Briganti, Alberto
AU - Carmignani, Luca
AU - Karakiewicz, Pierre I.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: Few data examined the potential survival benefit of nephroureterectomy (NU) in the setting of metastatic upper urinary tract urothelial carcinoma (mUTUC). We hypothesized that a survival benefit might be associated with the use of NU in that setting and tested this hypothesis within a large population-based cohort. Patients and Methods: Within the Surveillance, Epidemiology, and End Results database (2004-2014), we identified 1174 patients with mUTUC. Kaplan-Meier plots, as well as multivariable Cox regression models (MCRMs), relying on inverse probability after treatment weighting and landmark analyses, were used to test the effect of NU versus no surgical treatment on cancer-specific mortality (CSM) in patients with mUTUC. Results: Of 1174 patients with mUTUC, 449 (38%) underwent NU. The rate of NU decreased over time from 47.1% to 34.6% (estimated annual percentage change, −4%; P =.006]. In MCRMs, NU achieved independent predictor status for lower CSM (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.46-0.66; P <.001). In MCRMs stratified according to chemotherapy, NU also achieved independent predictor status for lower CSM, both in patients who received (n = 597; 50.9%) (HR, 0.68; 95% CI, 0.53-0.87; P =.002) or did not receive (n = 574; 49%) (HR, 0.44; 95% CI, 0.33-0.58; P <.001) chemotherapy. Virtually the same results were recorded after inverse probability after treatment weighting adjustment, as well as in landmark analyses. Conclusions: Our analyses suggest a potential survival benefit after NU in the setting of mUTUC, regardless of chemotherapy administration.
AB - Background: Few data examined the potential survival benefit of nephroureterectomy (NU) in the setting of metastatic upper urinary tract urothelial carcinoma (mUTUC). We hypothesized that a survival benefit might be associated with the use of NU in that setting and tested this hypothesis within a large population-based cohort. Patients and Methods: Within the Surveillance, Epidemiology, and End Results database (2004-2014), we identified 1174 patients with mUTUC. Kaplan-Meier plots, as well as multivariable Cox regression models (MCRMs), relying on inverse probability after treatment weighting and landmark analyses, were used to test the effect of NU versus no surgical treatment on cancer-specific mortality (CSM) in patients with mUTUC. Results: Of 1174 patients with mUTUC, 449 (38%) underwent NU. The rate of NU decreased over time from 47.1% to 34.6% (estimated annual percentage change, −4%; P =.006]. In MCRMs, NU achieved independent predictor status for lower CSM (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.46-0.66; P <.001). In MCRMs stratified according to chemotherapy, NU also achieved independent predictor status for lower CSM, both in patients who received (n = 597; 50.9%) (HR, 0.68; 95% CI, 0.53-0.87; P =.002) or did not receive (n = 574; 49%) (HR, 0.44; 95% CI, 0.33-0.58; P <.001) chemotherapy. Virtually the same results were recorded after inverse probability after treatment weighting adjustment, as well as in landmark analyses. Conclusions: Our analyses suggest a potential survival benefit after NU in the setting of mUTUC, regardless of chemotherapy administration.
KW - Chemotherapy
KW - SEER
KW - Upper tract
KW - Urothelial carcinoma
KW - UTUC
UR - http://www.scopus.com/inward/record.url?scp=85064321722&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064321722&partnerID=8YFLogxK
U2 - 10.1016/j.clgc.2019.03.003
DO - 10.1016/j.clgc.2019.03.003
M3 - Article
AN - SCOPUS:85064321722
VL - 17
SP - e602-e611
JO - Clinical Genitourinary Cancer
JF - Clinical Genitourinary Cancer
SN - 1558-7673
IS - 3
ER -